Purpose: Sinus elevation procedures have become a routine and reliable way to gain bone volume in the edentulous maxilla for dental implant placement. Presence of bony septations and pathology in the maxillary sinus often cause complications leading to graft or implant failure or both. The aim of this study was to retrospectively evaluate the prevalence of pathology, direction of the septa, and sinus width measured at 2 mm, 5 mm, and 10 mm from the sinus floor in maxillary sinuses using cone-beam computed tomography (CBCT). Materials and Methods: Seventy-two sinuses from 36 random preoperative CBCT scans referred for implant therapy were retrospectively evaluated for the number, prevalence, and direction of bony septations and presence of pathology. Width of the sinus was also measured at 2 mm, 5 mm, and 10 mm from the sinus floor to account for the amount of bone available for implant placement. Results: Maxillary sinus septa were found in 59.7%. Presence of a single septum was noted in 20 sinuses (27.7%), followed by two septa in 17 sinuses. The most common direction of the septum was the transverse direction. Retention pseudocyst and mucosal thickening were the most commonly seen abnormality/pathology. Conclusion: Based on the high prevalence of septa and sinus pathology in this sample, a preoperative CBCT scan might be helpful in minimizing complications during sinus augmentation procedures for dental implant therapy.
Purpose: To evaluate the anteroposterior length and buccal angle of the anterior loop, and the size and location of the mental foramen using cone beam computed tomography (CBCT). Materials and Methods: 100 CBCT images from 87 adults (43 males and 44 females) ranging in age from 20 to 73 years (average 50 years) with edentulous ridge of the mandibular premolar region were obtained. Axial, sagittal, coronal images were reconstructed from Dental and Block Images of CBCT. The anteroposterior length, shape and buccal angle of the anterior loop, and the size and location of the mental foramen were calculated from reconstructed images of axial, sagittal and coronal CBCT. Results: The anteroposterior length and buccal angle of the mental canal was 4.0${\pm}$1.2mm, 37.8${\pm}$11.60$^{\circ}$respectively. The loop type with straight course was the most common shape of the mental canal. The location of the mental foramen below the apex of the lower second premolar (78%) was the most common. The maximum size of the mental foramen was 4.6${\pm}$1.0 mm in width and 3.0${\pm}$0.6 mm in height. The inner size of the mental canal was 2.6${\pm}$0.6 mm in width and 2.1 mm${\pm}$0.4 mm in height. Conclusion: CBCT is useful to evaluate the anterior loop and mental foramen of the mandibular canal. Safe guideline of 4 mm from the most anterior point of the mental foramen is recommended for implant and surgical treatment. (Korean J Oral Maxillofac Radiol 2009; 39: 81-7)
The aims of this study were firstly to investigate soft tissue reactions around single implant-supported crowns and secondly to compare soft tissue dimensions and conditions of the crowns in relation to interdental papillae, and lastly to investigate patients'esthetic satisfaction with their single implant-supported crowns according to the interdental papillae presence/absence. Twenty-nine patients (41 implants) whose single missing tooth in the maxillary anterior region had been replaced by single implant-supported crown participated for the study and various variables of soft tissue conditions, dimensions and crown dimensions were measured around the single implant-supported crowns at clinical examination and from study models and slides. The results showed that the soft tissue conditions around the single implantsupported crowns were similar to those around implants used for partially or totolly edentulous patients. Except for the high frequency of bleeding on probing, all other parameters revealed healthy conditions. The buccal sites of the crown had a shallow pocket comparing with other sites. At all sites of the crown, similar status of little inflammation was found. Mesial sites and central-incisor positioned implantsupported crowns had lower contact point position than distal sites and lateral-incisor positioned crowns, respectively. Mucositis index, probing depth and contact point position were significantly correlated with papillae index(p < 0.05). More inflammation and lower contact point position were found at the implant-supported crown with no interdental space than that with interdental space. Patients showed high esthetic satisfaction regardless of interdental space presence. The result indicated that, despite of their submucosal crown margins, single implantsupported crowns have soft tissue conditions as good as other implants used for the treatment of the different types of edentulism and a clinician can manipulate interdental papilla height by modifying crown shapes within the limits of not violating total esthetics.
In general, the three major oral functions of edentulous patients-mastication, phonation, esthetics-can be rehabilitated by the complete dentures, and both the resin based complete denture and the metal based complete denture are commonly used by many clinicians today. For the sake of many advantages such as the excellent thermal conductivity, low volumetric change, high strength, low risk of fracture and the better patient's adaptation, the metal based complete dentures are indicated to the several cases. But, there are common failures of these type of dentures mainly by the fracture or the debonding between the resin structures and the metal frameworks which is caused by the discrepancies of the flexural strength and the coefficient of thermal expansion. This is aggravated by the water contamination of the interface when exposed to the oral environment and results in the failure of complete denture treatment. So, the purpose of this study is to compare the bond strength and the fracture patterns of the gold alloy based and the Co-Cr alloy based complete dentures using the PMMA resins and the 4-META adhesive resins. The results of this study were as follows. 1. Both to the PMMA resin and the 4-META resin, the flexural bond strength of gold alloy is lower than that of Co-Cr alloy(P<0.05) 2. To the Co-Cr alloy, the bond strength of the 4-META resin is significantly higher than that of PMMA resin(P<0.05). 3. The flexural strength of the group with the mechanical retention form is significantly higher than that of the group without retention form(P<0.05). 4. Comparing with the other groups, the fracture patterns of the group 3 are quite different from the group 1,2,5.
The aim of present study was to evaluate the influence of periodontal status of adjacent tooth and loading time to the prevalence of red complex of implant sulcus. In 97 patients, partially edentulous subjects with endosseous root-form implants were selected. All subjects were medically healthy and had not taken systemic antibiotics and professional plaque control 3 months before sampling. The number was as follows: clinically healthy implants:161, clinically unhealthy implants:22, clinically healthy adjacent teeth:73, clinically unhealthy adjacent teeth:38. All teeth and implants of each patient were examined probing depth(PD), modified sulcus bleeding index(mSBI), and modified plaque index(mPI), and samples of subgingival plaque were obtained at each site with sterile curet or fine paper points, then the plaque transferred to PBS. Obtained samples were examined for the presence of P. gingivalis, T. forsythensis, and T. denticola by the polymerase chain reaction (PCR). The relationship among clinical parameters and the colonizations by the 3 bacterial species from adjacent teeth and implants region were analyzed by student t-test (p<0.05). The results of this study were as follows: 1. mPI and mSBI of implant increased with increasing of same indices of adjacent tooth(p=0.03,0.001), but not in the PD . 2. The mPI, mBI, PD of implants was higher when red complex exist. 3. The prevalence of red complex was higher when the periodontal condition is unhealthy. 4. The prevalence of red complex of implants has no significant relation to the probing depth of adjacent tooth. 5. Prevalence of P. gingivalis, T. forsythensis of implants increased with loading time. (p=0.02,0.018) These results shows the importance of oral hygiene and supportive periodontal therapy.
Park Hong-Ryul;Kim Seong-Kyun;Koak Jai-Young;Heo Seong-Joo;Chang Ik-Tae
The Journal of Korean Academy of Prosthodontics
/
v.43
no.2
/
pp.218-231
/
2005
Statement of problem. In the partially edentulous patients, removable partial dentures have been working as a important treatment modality. Clasps, a kind of direct retainers, received some amount of stresses during the insertion and removal of partial denture on the abutment tooth. Purpose. The study is to investigate stresses of the different clasps. Material and methods. In order to investigate the degree of stresses, maxillary partial edentulism (Kennedy Class II modification I) was assumed and removable partial dentures were designed on it with three kinds of metallic materials; cobalt-chromium alloy, type IV gold alloy and commercially pure (c.p.) titanium. Aker's clasp was applied on the left second molar. RPA (mesial rest-proximal plate-Aker's) clasp was on the left first premolar and wrought wire clasp was on the right first premolar. Three dimensional, non-linear, dynamic finite element analysis method was run to solve this process. Results. 1. Cobalt-chromium alloy had the highest von Mises stress value and c.p. titanium had the lowest one irrespective of the types of clasps. 2. In the Aker's clasps, stress on the retentive tips was shown shortly after the appearance of stresses of the middle and minor connector areas. These time lag was much shorter in the RPA clasps than in the Aker's clasp. 3. In general. retentive tips of wrought wire clasps had much less amount of stress than other clasps. Conclusion. The amount of stress was the highest in the RPA clasp and the lowest in the wrought wire clasp, in general.
Statement of problem. Use of the conventional dental impression procedure is problematic in patients who have difficulty opening their mouth, difficulty breathing through their nose or tendency to gag. Purpose. It is necessary to make individual trays more comfortable for patients during impression taking procedure. It was reported at the KAP Annual Meeting 2001 Seoul that an improved impression technique was suitable for this purpose. In this study, the accuracy of the improved dental impression method for implant was compared with the conventional dental impression method. Material and methods. An oral simulator was made from clear acrylic resin block which had similar form of edentulous ridge. For setting up the standard, five fixtures were installed on it. Study casts were made using two kinds of impression techniques. One was the conventional method that was taken using silicone impression material and an individual resin tray under connection of inter-fixture relation. The other was the improved method in which was the connection of the impression coping and the thermoformed polymethyl methacrylate tray. In addition, two different study casts were made from the improved impression body. The coordinates of the fixture on the study model were measured by three-dimensional coordinate measuring equipment. Then the distances between each fixture were calculated and compared with that of oral simulator. Accuracy of the each impression method was also assessed. Results. The differences of inter-fixture dimension between study casts and simulator in the improved impression technique showed $0.014{\pm}0.016mm$ and $0.017{\pm}0.022mm$, respectively and that of the conventional method was $0.017{\pm}0.014mm$. There was no significant difference between the improved impression technique and conventional method. Conclusion. The improved impression technique is useful for multiple support implants.
In the anterior maxillary area, dental implants for tooth replacement are challenging due to the need to satisfy high esthetic level as well as functionality. Immediate implant placement and provisionalization can dramatically reduce the edentulous period, and then fulfill patient's demand for esthetics. The aim of present case report is to demonstrate two cases that successfully restored single tooth with immediate implant placement and provisionalization in the anterior maxillary area. A 47 years old female was scheduled to replace her maxillary right central incisor due to crown-root fracture by trauma. Another 54-year-old female was planned to place dental implant following tooth extraction of maxillary right lateral incisor owing to continuous pus discharge despite repetitive treatments including apicoectomy. In these two cases, surgical and prosthetic procedures progressed in a similar way. After minimal flap elevation, atraumatic tooth extraction was performed. Implant was placed in proper 3-dimensional position and angulation with primary stability. Bone graft or guided bone regeneration for peri-implant bone defect was conducted simultaneously. Provisionalization without occlusal loading was carried out at the same day. Each definitive crown was delivered at 7 and 5 months after the surgery. Two cases have been followed uneventfully for 2 to 5 years of loading time. In conclusion, Immediate implant placement and provisionalization could lead to esthetic outcome for single tooth replacement with dental implant under proper case selection.
The calcifying odontogenic cyst was identified as a pathological entity by Gorlin & his associates in 1962. This lesion is one of the rarest and most disputable cysts in the oral region. The calcifying odontogenic cyst has variable clinical and radiological features. We review the previous literatures and report 2 cases of calcifying odontogenic cyst at Department of Oral and Maxillofacial Surgery, Kyung-Hee University. The 1st case was as follows. The patient vas 22 year old female. The past dental history revealed extraction of prolonged retained #73 tooth about 15days ago. She complained a painful swelling on the lower anterior teeth area. There were chin and vestibular swelling on the lower anterior teeth area, tenderness and missing of #33 tooth. The radiograph revealed well-demarcated unilocular radiolucency containing radiopaque calcific flecks around impacted #33 tooth. The clinical diagnosis was COC, so surgical enucleation was done. There was no recurrence and COC was confirmed by pathologist. The second case was as follows. The patient was 72 year old male. The past history revealed inactive tuberculosis, bronchial asthma and denture construction. The chief complaint was rapidly growing mass on the lower left anterior edentulous area. The clinical findings were chin swelling protruding mass with surface ulceration, fluctuation and a few bloody fluid in aspiration. The radiograph revealed well-demarcated radiolucency mimiking the residual cyst. The biopsy result was COC. The surgical excision was done, but the lesion was recurred 10 months later. The treatment was surgical excision with aggressive peripheral bone grinding and FTSG form groin area. There was no problem during the postoperative period.
In general, labiolingual or buccolingual widths of residual alveolar bone are insufficient in edentulous area, because of alveolar resorption. Horizontal augmentation is bone graft procedure with a view to reinforcing horizontally insufficient bone quantity for installation of implants. The standard method is taking appropriate amount of block bone from intraoral or extraoral autogenous bone, and solid fixation with screws or mini-plate on labial or buccal side of residual alveolar bone. The purpose of this study is to discuss clinical usefulness of horizontal augmentation with autogenous block bone by observation and analysis of course of 41 implants installed to 12 patients by horizontal augmentation in Seoul National University Bundang Hospital from July, 2002 to December, 2005. The mean age of patients is 52.7, from 19 to 70, and the number of men and women is each 2 and 10. Block bone was taken from symphysis, body, ramus of mandible or iliac bone. And 6 types of implants were installed simultaneously or not, the diameters of implants are from 3.3 to 5.5mm, the lengths are from 8 to 15mm. The operator added artificial bone grafting material and optionally covered with membrane. The mean periods of observation after operation and final prosthetics were 28.6 and 17.0 months. As a result, 40 among 41 implants survived, the survival rate was 97.6%. Average 0.9mm crestal resorption was observed at final point of time by periapical view of each patients. Major complication related to the procedure was numbness in 7 patients.
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